Adult I Theory - Exam Two

5,000-10,000/microliter

What are normal WBC levels?

4.4-6.1 x 10^6/microliter

What is a normative range for RBC?

12-16 g/dL

What is a normal hemoglobin level?

36-52%

What is a normal range for hematocrit?

150,000-400,000/microliter

What is a normal platelet count?

Anemia

A deficiency in the number of RBC, the quantity of hemoglobin, and/or the volume of packed RBC (hematocrit).

True

True or False: Anemia is not a specific disease and is often a symptom of another underlying problem.

- Impaired RBC construction

- Impaired nutrition

- Decreased iron availability

- Decreased erythropoietin

- Blood loss

- Increased RBC destruction

What are some possible causes of anemia?

Normocytic

Blood cells are normal is size and color.

Macrocytic, Normochromic

Blood cells are large in size, but normal in color.

Microcytic, Hypochromic

Blood cells are small in size, but pale in color.

- Blood loss

- Chronic renal disease

- Aplastic anemia

For what clinical manifestations would normocytic blood cells be common?

- Cobalamin deficiency

- Folic acid deficiency

- Liver disease

- Postsplenectomy

For what clinical manifestations would macrocytic, normochromic blood cells be common?

- Iron deficiency anemia

- Thalassemia

- Lead poisoning

For what clinical manifestations would microcytic, hypochromic blood cells be common?

Levels less than 6 g/dL

What hemoglobin level would determine a severe form of anemia?

True

True or False: Mild to moderate forms of anemia typically are asymptomatic, but the patient may experience activity intolerance (i.e. dyspnea and palpitations).

- Pallor

- Jaundice

- Pruritus

What changes may a person see to their skin with severe anemia?

- Blurred vision

- Retinal hemorrhage

Wha changes may a person see to their eyes with severe anemia?

- Glossitis

- Smooth tongue

What changes may a person see to their mouth with severe anemia?

- Tachycardia

- Angina

- Intermittent claudication

- CHF

- MI

- Murmur

What cardiovascular changes may a person experience with severe anemia?

- Tachypnea

- Orthopnea

- Dyspnea at rest

What pulmonary changes may a person experience with severe anemia?

- HA

- Vertigo

- Impaired thoughts

What neurologic changes may a person experience with severe anemia?

- Anorexia

- Hepatomegaly

- Difficulty swallowing

- Sore mouth

What gastrointestinal changes may a person experience with severe anemia?

Bone pain

What musculoskeletal changes may a person experience with severe anemia?

- Weight loss

- Fatigue

- Sensitivity to cold

What general symptoms may a person with severe anemia report?

- Assume normal activities of daily living.

- Maintain adequate nutrition.

- Develop no complications related to anemia.

What are the overall goals for a person with anemia?

False; they are typically not used unless counts are dangerously low. Often, the risks associated with blood transfusions outweigh the pros.

True or False: Blood and blood product transfusions should always be the first step for people with anemia.

- Iron-deficiency anemia

- Thalassemia

- Megablastic anemias

- Aplastic anemia

What forms of anemia are caused by decreased erythrocyte (RBC) production?

- Very young

- Those with poor diets

- Women in their reproductive years

Who is most susceptible to iron-deficiency anemia?

- Inadequate diet

- Malabsorption

- Blood loss

- Pregnancy

- Chronic renal failure

- Surgery

What may be high risks for developing iron-deficiency?

- Early on, asymptomatic

- Pallor

- Glossitis

- Chelitis

- Headache

- Burning sensation of the tongue

What are clinical manifestations of iron-deficiency anemia?

- Hb/Hct will be decreased

- TIBC (iron binding capacity) will be elevated

What will diagnostic testing show if a patient has iron-deficiency anemia?

One hour prior to meals and with some form of vitamin C (i.e. OJ).

How should iron supplements be taken?

GI upset

What side effects are common with iron supplements?

Ferrous Sulfate

Iron supplement commonly used to prevent and treat iron deficiency anemia (dietary supplement).

- Antacid

- Tetracyclines

- Cimetidine

What drugs may interfere with iron absorption?

- Anorexia

- Nausea

- Vomiting

- Constipation (common)

- Diarrhea

- CNS toxicity progressing to coma and death with overdose

- Black stools

What are possible adverse effects of ferrous sulfate?

This prevents the skin from being stained.

Why should separate needles for drawing up and administering ferrous sulfate, as well as the Z track method be used?

- Legumes

- Liver

- Beans

- Dark, green, leafy vegetables

- Fish

- Eggs

- Whole-grain and enriched breads and cereals

- Beef

What foods are high in iron?

Cholesterol

While liver is high in iron, it is also high in ___________ and older adults who have high levels of this should be cautious with consumption.

2-3 months

After hemoglobin levels have returned to normal, how long must patients continue to take iron therapy in order to replenish their stores?

Liver

What organ needs to be monitored in patients on long term iron?

Megaloblastic Anemia

Anemia caused by impaired DNA synthesis and characterized by the presence of large RBC and abnormal RBC that are easily destroyed.

- This includes cobalamin and folic acid deficiency.

True

True or False: A protein secreted by the parietal cells of the gastric mucosa, called the intrinsic factor, is required for cobalamin absorption, but damage to the stomach, gastric bypass and increased age may damage these cells, resulting in decreased absorption.

Pernicious anemia

What is the most common cause of cobalamin deficiency?

It is caused by the absence of intrinsic factor from either gastric mucosal atrophy or autoimmune destruction of parietal cells.

What is pernicious anemia?

- GI surgery

- Small bowel resection

- Crohn's disease

- Ileitis

- Celiac disease

- Deverticuli

- Smoking

- Excessive alcohol/hot tea consumption

What are other causes of cobalamin deficiency?

Neuromuscular manifestations:

- Weakness

- Paresthesia of the feet and hands

- Ataxia

- Muscle weakness

- Impaired thought process

What manifestation of symptoms is unique to cobalamin deficiency anemia?

Macrocytic and abnormal

How do RBC appear in cobalamin deficiency?

True

True or False: People with cobalamin deficiency are at a greater risk of stomach cancer, thus biopsies and scopes are performed more regularly.

- Parenteral nutrition

- Intranasal

Because cobalamin cannot be absorbed if IF is lacking, how else may therapy be provided?

- Poor nutrition

- Malabsorption syndrome

- Drugs such as Methotrexate, oral contraceptives or anti seizure medications

- Increased requirements (i.e. pregnancy)

- Alcohol use

- Anorexia

- Hemodialysis

What causes folic acid deficiency?

GI disturbances:

- Dyspepsia

- Stomatitis

- Diarrhea

- Flatulence

- Smooth, beefy red tongue

- Absence of neurologic involvement

What side effects are common with folic acid deficiency?

- Serum folic acid is low (normal 3-25 mg/ml)

- Serum cobalamin level is normal

What do diagnostic studies show for people with folic acid deficiency?

- Supplementation

- Diet high in folic acid

*Cannot be toxic; body will excrete excess*

What is done for people who are folic acid deficient?

- Green, leafy vegetables

- Enriched grains and breakfast cereals

- Orange juice

- Peanuts

- Fish

What foods are high in folic acid?

A disease in which the patient has peripheral blood pancytopenia and hypocellular bone marrow.

What is aplastic anemia?

The presence of low RBC, platelets and WBC.

What is pancytopenia?

- Congenital

- Autoimmune

- Environmental

What may cause aplastic anemia?

- Develops gradually

- Thrombocytopenia

- Symptoms caused by suppression of any and all bone marrow

What are the clinical manifestations for aplastic anemia?

- Hemoglobin, WBC and platelets are decreased.

- Bone marrow aspiration is increasingly yellow and marrow is hypocellular.

For people with aplastic anemia, what do diagnostic studies reveal?

- Isolation room

- A roommate who is considered "clean"

For hospitalized patients with aplastic anemia, what area is best?

- Hematopoietic stem cell transplant

- Immunosuppressant treatment

- Steroids

- Cyclosporine

- Supportive blood transfusion

What treatment is available for aplastic anemia?

Replacing the blood volume to prevent shock and identifying the source of hemorrhage and stopping it.

For patients with acute blood loss, what is the number one priority?

True

True or False: Negative blood types can only receive negative blood types.

O-

What is the universal blood donor type?

AB+

What is universal acceptor blood type?

The first fifteen minutes.

For how long should the patient be monitored when blood infusion begins?

30 minutes

How long does the nurse have to begin blood transfusion once it is brought to the unit?

HF

What is the number one concern for administering blood too quickly?

- Alert HCP and blood bank.

- Disconnect blood and administer saline.

- Monitor vital signs and urine output.

- Treat symptoms per physician order.

- Save blood bag and tubing to send back to blood bank for testing.

- Collect blood/urine specimen as ordered.

If a patient has a blood transfusion reaction, what should be done?

True

True or False: If a patient experiences a fever or a mild allergic reaction to a blood transfusion, it may be continued if considered life-saving.

Pneumonia

An acute infection of the lung parenchyma.

Smokers

What patients are more susceptible to pneumonia, compared to the general population?

Children and older adults (extremes of life).

What groups are most likely to acquire pneumonia?

- Abdominal/chest surgery

- Age (> 65)

- Air pollution

- Altered LOC

- Prolonged immobility

- Enteral feeding

- Exposure to animals (bats, birds, etc.)

- Immunosuppression

- Smoking

- Tracheal intubation

- Resident of LTC

- URIs

What are risk factors for developing pneumonia?

- Aspiration

- Inhalation

- Hematogenous Spread

What are the three ways in which pneumonia may be acquired?

Community Acquired Pneumonia (CAP)

Pneumonia that occurs in patients who have NOT been hospitalized/resided in a long-term care facility within 14 days of onset of symptoms.

True

True or False: The decision to treat pneumonia in the hospital setting or at home is determined by the patient's stability and condition.

Hospital Associated Pneumonia (HAP)

Occurring 48 hours or longer after admission and not intubated at time of hospitalization.

Ventilator Associated Pneumonia (VAP)

Occurs more than 48 hours after endotracheal intubation.

True

True or False: Hospital acquired pneumonia requires more aggressive treatment because these strains are typically resistant.

After cultures have been obtained, a general antibiotic will be started to begin treatment until exact cause is discovered. From there, the antibiotic will be adjusted.

What is empiric antibiotics in terms of pneumonia treatment?

- Viral

- Bacterial

- Mycoplasma

- Aspiration

- Necrotizing

- Oppurtunic

What are the different types of pneumonia?

After patients have received:

- Radiation therapy

- Chemotherapy

- Corticosteroids

(The immune system is vulnerable so the pathogens take the OPPORTUNITY to colonize).

When is the development of opportunistic pneumonia most likely to occur?

Those with a history(s) of:

- Altered LOC

- Dysphagia

- NG tubes

What patients are most likely to develop aspiration pneumonia?

- Lung abscess

- Respiratory insufficiency/failure

- Leukopenia

- Bleeding in the airway

What are side effects of necrotizing pneumonia?

The inflammatory process attracts more neutrophils and edema into the airway and fluid leaks from the capillaries and tissues into the alveoli, resulting in possible atelectasis and consolidation.

What is the pathophysiology of pneumonia?

- Cough

- Fever

- Dyspnea

- Tachypnea

- Pleuritic chest pain

- Possible sputum that may be green, yellow or rust-colored

- Fine, course crackles

- Egophony

- Bronchial breath sounds if consolidated

- Increased fremitus

- Dullness on percussion (if pleural effusion present)

What are common clinical manifestations of pneumonia?

The levels will be normal, but the neutrophils will be increased (bacterial response).

For patients with pneumonia, what may the WBCs present as?

- Diaphoresis

- Anorexia

- Fatigue

- Myalgias

- Headache

- Abdominal pain

What are nonspecific clinical manifestations that may be indicative of pneumonia?

- Pleurisy

- Pleural effusion

- Bacteremia

- Empyema

- Meningitis

- Sepsis/septic shock

- ARF

- Pneumothorax

What complications are a concern with pneumonia?

Pneumonia

A 75 year old male is brought into the ER by his daughter. The patient reports feeling "unwell and tired," has a temperature of 95.6 and appears confused as to why they are at the hospital. After obtaining cultures, what most likely will be the diagnosis?

- History and physical

- Chest x-ray

- Gram stain of sputum

- Sputum culture and sensitivity

- Pulse Ox

- CBC

- Blood cultures

What diagnostic tests are used for pneumonia?

Typically, responses to drugs start within 48-72 hours of initial dose.

A patient with no comorbidities began on antibiotics for pneumonia today. She asks the nurse how long it will take until she feels better. How will the nurse respond?

Question the doctor about the order. Antibiotics do not work for viral infections!

A patient newly diagnosed with viral pneumonia sees that a patient is prescribed an antibiotic regimen. What would the nurse do next?

Six to eight weeks after diagnosis.

For patients with pneumonia diagnoses, when should follow up chest x-rays be performed?

They need to be drinking at least three liters of fluids a day to enhance hydration and help with secretion mobility.

For patients with a pneumonia diagnosis, what nutritional idea is vital to educate them on?

- Homeless

- Residents of inner-city neighborhoods

- Foreign born persons

- Person living/working in institutions

- IV drug users

- Overcrowded living conditions

- Less than optimal sanitation

- Poor access to healthcare

- Immunosuppressed persons

- HIV positive patients

What patients are at high risk for tuberculosis?

True

True or False: TB is spread via airborne droplets, but is not highly infectious unless there is close, frequent and prolonged exposure to a person who has active TB. In other words, touching, sharing food off the same utensils and kissing will not lead to transmission.